Chronic Renal Failure In Children Research Articles

Mid-short-term risk factors for chronic renal failure in children with posterior urethral valve.

To analyze the mid-short-term risk factors for chronic renal failure (CRF) in children with posterior urethral valve (PUV) after valve ablation. A retrospective study of 143 patients with PUV who underwent operation was performed. Patients were divided into CRF group (n = 39) and non-CRF group (n = 104). Clinical data of both groups such as the first resection age, last resection age, number of operations, the maximal detrusor pressure (Pdetmax), and vesicoureteral reflux (VUR) were collected and analyzed. The first resection age, last resection age, and the Pdetmax of patients in the CRF group were higher than those of patients in the non-CRF group (P < 0.05). Multiple regression analysis showed that the indicators related to chronic renal failure were last resection age (β = 1.034, P < 0.05) and Pdetmax (β = 1.068, P < 0.05). The cut-off value of last resection age was 35.5months, Pdetmax was 41.65cmH2O. There was positive correlation of final blood creatinine with last resection age and Pdetmax. The last resection age and Pdetmax are the risk factors of chronic renal failure in children with PUV. A Pdetmax of lower than 41.65cmH2O indicates a good prognosis of renal function in patients with PUV.

Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves

Posterior urethral valves (PUV) is a leading cause of chronic renal failure in childhood. Bladder and posterior urethral deformity in infants with PUV are highly variable on initial voiding cystourethrogram (VCUG). Some types of deformity may be more important than others in determining the severity of the condition. Identification of specific VCUG features may allow for a simple, early screening assessment for patients. Determine whether morphologic features on the initial VCUG correlate to renal outcomes as measured by the creatinine nadir in the first year after ablation. Children with PUV treated by primary valve ablation before 12 months old and followed >1 year were identified. Initial diagnostic VCUG was evaluated for the bladder height to width ratio (HW-B), posterior urethral height to width ratio (HW-PU), and posterior-anterior urethral ratio (PA-UR). A trabeculation grade was assigned by three pediatric urologists, and reflux was noted. Univariable analyses with chi-square and t-test were used to compare bladder and posterior urethral morphology factors among those who obtained a creatinine nadir <0.8 or ≥0.8mg/dL in the first year after ablation. Linear regression was performed to correlate morphology values with true creatinine nadir. A total of 120 boys were ablated at mean age of 40.5 days (range 0-342) and followed for 5.9 years (± 3.85). Among these, 21 (17.5%) had a creatinine nadir ≥0.8mg/dL. Mean overall HW-B and mean PA-UR were not significantly different between those with creatinine nadir <0.8 versus ≥0.8mg/dL. Bladder trabeculation grade was not associated with creatinine nadir. For the entire cohort, only the difference in HW-PU was statistically significant between creatinine nadir groups with a much higher ratio among those with a nadir ≥0.8 (p<0.001). Linear regression demonstrated a significant positive correlation between the HW-PU and creatinine nadir (R 2=0.097, p=0.002). The presence of bilateral reflux is significantly associated with creatinine nadir ≥0.8mg/dL (p=0.001). We investigate for the first time the association of morphology features on the initial VCUG with renal outcome in PUV patients. Posterior urethral deformity as quantified by a higher HW-PU ratio is significantly correlated with a higher creatinine nadir, whereas measured bladder morphology metrics are not. HW-PU may be an indirect measure of the severity of obstruction in posterior urethral valves. The HW-PU appears to be a meaningful early morphologic metric for renal outcome.

Kidney Transplant in a Pediatric Patient With Congenital Abnormalities of the Urinary Tract.

Kidney transplant is the gold standard surgical treatment for patients with end-stage chronic kidney disease. Over the past decade, the frequency and prevalence of chronic kidney disease in children have been increasing, with it being a serious problem worldwide. Kidney transplant in Uzbekistan is still at an early stage, with the first successful kidney transplant performed in 2018. Here, we describe a successful kidney transplant in a pediatric female patient with a congenital abnormality of the urinary tract. The patient first showed symptoms at 7 years of age and was diagnosed with urolithic illness with inflammation of both kidneys. At presentation, she was 14 years of age with end-stage chronic kidney disease (diagnosed with stage 5 chronic kidney disease at age 13 years) caused by an anomaly in the development of the urinary tract. She received a kidney transplant from her mother as a living donor. There was vesicoureteral reflux on both sides and ureterohydronephrosis from 2 sides. On day 9 posttransplant, her creatinine level decreased from 0.40 to 0.066 mmol/L. Doppler ultrasonogram showed normal size and echogenicity of the graft, as well as adequate blood flow in the renal and iliac vessels. The patient was discharged on day 10 posttransplant in a satisfactory condition. In about 50% of cases, the cause of chronic renal failure in children is congenital anomalies of the urinary tract. The most common causes of hydronephrosis in newborns and children are vesicourethral reflux, which leads to the expansion of the urinary tract collecting system and the development of chronic renal failure. Early and accurate diagnosis and timely treatment of urinary tract abnormalities can reduce the incidence of end-stage chronic kidney disease in children.

POS-379 TO INVESTIGATE THE EFFECT OF HERBA LYSIMACHIAE IN THE TREATMENT OF OBSTRUCTIVE NEPHROPATHY BASED ON STAT-1/TREM-1 PATHWAY

Obstructive nephropathy is a major cause of chronic renal failure in children and adults.Clinical and animal experiments have found that renal damage still exists after obstruction is relieved, which is mainly related to irreversible fibrosis changes caused by persistent inflammatory infiltration, and there is no specific medicine for western medicine treatment. Herba lysimachiae can detoxify detumescence, diuresis tonglin, has a certain kidney protection. However, there is still a lack of systematic knowledge about the herba lysimachiae components and mechanism of s. chinensis in the treatment of obstructive nephropathy. Twenty SD rats were randomly divided into Sham operation group (Sham), unilateral ureteral obstruction operation group (UUO), Pennyswort intervention Sham operation group (Sham+Lys), herba lysimachiae intervention model group (UUO+ Lys).From the 1st day after surgery, the decoction of herba lysimachiae was given 24g/kg, once a day, for continuous 2w.Or intragastric administration of normal saline at the same time.Routine biochemical kit was used to detect renal function 2 weeks later.Renal tubule dilatation, mesangial hyperplasia and renal interstitial fibrosis were detected by HE, PAS and Masson staining.Immunohistochemistry and immunofluorescence were used to detect the activation of STAT-1/ TreM-1 pathway, macrophage aggregation (CD68+ iNOS+), renal tubular injury markers (KIM-1), and fibrosis related molecules (α-SMA, TGF-beta) in renal tissues. In the model group, the renal tubules were oppressed by urine retention on the obstructed side. Pathological staining showed that the epithelial cells of the renal tubules were necrotic to varying degrees, and the interstitial was infiltrated by acute and chronic inflammatory cells. Some of the necrotic renal tubules were gradually replaced by fibrous scar, and the formation of renal interstitial fibrosis was visible.Biochemical tests showed that the creatinine and renal injury scores were significantly higher than those of the normal group.Immunohistochemistry/immunofluorescence assay showed increased stat-1 /TREM-1 expression.Abnormal aggregation of M1-type macrophages in renal interstitium, accompanied by renal injury and fibrosis, showed increased expressions of KIM-1, α-SMA and TGF-beta (all P<0.05).In contrast, stat-1 /TREM-1 expression was decreased in renal tissue after herba lysimachiae intervention, and the above inflammatory and fibrosis related indicators were improved (P<0.05). Herba lysimachiae can protect renal function and inhibit renal inflammation and fibrosis in UUO rats, and this mechanism is related to the STAT-1/TREM-1 pathway.

MP51-01 COMPARATIVE ANALYSIS OF CREATININE NADIR CUTOFFS FOR PREDICTING CHILDHOOD RENAL OUTCOMES IN POSTERIOR URETHRAL VALVES

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-01 COMPARATIVE ANALYSIS OF CREATININE NADIR CUTOFFS FOR PREDICTING CHILDHOOD RENAL OUTCOMES IN POSTERIOR URETHRAL VALVES Charlotte Wu, Emily Blum, Dattatraya Patil, Stella Shin, and Edwin Smith Charlotte WuCharlotte Wu More articles by this author , Emily BlumEmily Blum More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Stella ShinStella Shin More articles by this author , and Edwin SmithEdwin Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Posterior urethral valves (PUV) are a leading cause of chronic renal failure in childhood. A consistently validated prognostic indicator of renal outcomes is the creatinine nadir. Higher nadirs above historical cutoff values of 0.8 or 1.0 mg/dL correlate with worse renal outcomes. The ability to distinguish early creatinine values more elaborately for patient counseling remains otherwise limited. METHODS: Children with PUV treated by primary valve ablation before 12 months old and followed >2 years were identified. Patient factors including creatinine at presentation (Cr-P), nadir at 6-weeks after ablation (Cr-6W), and nadir at 1 year after ablation (Cr-1Y) were assessed as predictors of final chronic kidney disease (CKD) stage. An optimal threshold for four CKD levels was defined in incremental fashion using binary outcome with receiver operating characteristic (ROC), then multivariable logistic regression models compared Cr-P, Cr-6W, and Cr-1Y while adjusting for patient factors. RESULTS: A total of 102 boys were ablated at a mean age of 36.3 (range 0-334) days and followed for 6.6 (±3.7) years. Overall progression to ESRD was 17%. Univariate analysis demonstrated a significant association between lower gestational age and higher Cr-P, Cr-6W, Cr-1Y with incrementally higher CKD stages. On multivariable analysis, when compared to other demographics, only creatinine remained independently, significantly predictive of CKD outcomes. ROC analysis of creatinine for predicting CKD demonstrated excellent diagnostic accuracy for Cr-6W and Cr-1Y (p<0.001) and acceptable accuracy for Cr-P (p<0.005). Using the Cr-6W and Cr-1Y models, high sensitivity and specificity creatinine nadir cutoffs were determined to predict each CKD outcome (Table 1). CONCLUSIONS: Cr-6W and Cr-1Y are both excellent predictors of childhood CKD outcomes and are superior to Cr-P. A Cr-6W cutoff of 1.0 mg/dL and Cr-1Y cutoff of 0.8 mg/dL are highly specific and sensitive for ESRD. Children with nadir below historic cutoffs of 0.8 or 1.0 mg/dL do not universally experience a benign renal course. The threshold for concern for CKD3 or higher, for which medical treatment is typically initiated, should start at a Cr-6W nadir > 0.5 mg/dL or Cr-1Y nadir >0.3 mg/dL. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e896-e896 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charlotte Wu More articles by this author Emily Blum More articles by this author Dattatraya Patil More articles by this author Stella Shin More articles by this author Edwin Smith More articles by this author Expand All Advertisement Loading ...

Etiologies of Chronic Renal Failure in Adolescent Patients at the University Hospital of Brazzaville

Objectives: The aim of our work was to identify the etiologies of chronic renal failure in adolescent patients. Patients and Methods: This is a descriptive cross-sectional retrospective study that included adolescents aged 10 to 19 years hospitalized between January 2014 and December 2017 in the department of nephrology at the University Hospital of Brazzaville. The CRF was defined according to the ANAES criteria by an estimated glomerular filtration rate less than 60 ml/min/ 1.73 m2 of body surface. Results: Forty cases of CRF were collected, representing a prevalence of 4.9%. The average age was 16.32 ± 3.64 years and the sex ratio was 3. The most common mode of discovery was edematous syndrome 62.5%. The most common etiology was glomerular nephropathies 60%, hereditary nephropathies 25% and malformative uropathies in 15%. Ten patients (25%) had moderate CFR at admission, 62.5% had severe CRF, 12.5% had terminal CFR and all of them died during the year. Conclusion: Epidemiological data CRF in adolescent patients in developing countries are scarce and limit treatment. Glomerular pathologies represent the most frequent etiology. Early treatment of chronic renal failure in childhood and multidisciplinary collaboration between pediatrician and nephrologist are necessary.

Copy-number variation of the NPHP1 gene in patients with juvenile Nephronophthisis

ABSTRACT Objective: Juvenile nephronophthisis (NPHP) is an autosomal recessive cystic disease of the kidney. It represents the most frequent genetic cause of chronic renal failure in children. Methods: we investigated clinical and molecular features in two children with Juvenile nephronophthisis using firstly Multiplex ligation-dependent probe amplification (MLPA) and secondly multiplex PCR. Results: we report a homozygous NPHP1 deletion in two children. Conclusion: NPHP1 deletion analysis using diagnostic methods (e.g. MLPA, Multiplex PCR) should always be considered in patients with nephronophthisis, especially from consanguineous families. Our results provide insights into genotype-phenotype correlations in juvenile nephronophthisis that can be utilized in genetic counseling.

SCREENING FOR ASYMPTOMATIC BACTERURIA IN CHILDREN WITH OBSTRUCTIVE UROPATHY

Background: Obstructive uropathy is an important cause of chronic renal failure in children. Obstruction of the urinary tract blocks adequate urine flow. It causes urine stasis, and predisposes the child to asymptomatic bacteruria (ABU) that needed to be followed up to early detect symptomatic UTI. Objective: Screening of ABU in children who were suffering from obstructive uropathy to avoid unnecessary use of antibiotics, early detection and treatment of children who developed symptomatic urinary tract infection (UTI), and relation between type of obstructive uropathy and body growth. Patients and methods: Cross sectional descriptive study was conducted on 50 children with different types of obstructive uropathy. They were selected according to certain inclusion and exclusion criteria from Pediatric Nephrology and Urology outpatient clinics at Al- Hussein University Hospital. Their ages ranged from 2.2 to 11 years. They were subjected to full medical history, complete clinical examination, and routine investigations including renal function tests, urine analysis, urine culture, and imaging studies (included pelvi-abdominal ultrasonography, magnetic resonance urography, renal scan and voiding cystourethrogram). Results: Obstructive uropathy was more common in males (62%) than females (38%), while ABU was common in females. The growth of our patients was not affected by different types of obstructive uropathy. 68% of patients had no bacterial growth, while 32% had bacterial growth in urine culture. The commonest organism was E coli (56.25%). Glomerular filtration rate (GFR) was not significantly affected by different types of obstructive uropathy. Conclusion: Obstructive uropathy can predispose to colonization of bacteria in urinary tract and development of asymptomatic bacteruria especially in females that needs to be followed up. Follow up is needed to early detect symptomatic UTI.

The underlying causes of chronic renal failure in children and the elderly

The underlying causes of chronic renal failure in children and the elderly

Хроническая почечная недостаточность у детей Алтайского края

Хроническая почечная недостаточность у детей Алтайского края

Characterization of two novel mutations in the claudin-16 and claudin-19 genes that cause familial hypomagnesemia with hypercalciuria and nephrocalcinosis

Familial hypomagnesemia with hypercalciuria and nephrocalcinosis is an autosomal-recessive renal tubular disorder characterized by excessive urinary losses of magnesium and calcium, bilateral nephrocalcinosis and progressive chronic renal failure in childhood or adolescence. The disease is caused by mutations in the tight-junction proteins claudin-16 and claudin-19 that are encoded by the CLDN16 and CLDN19 genes, respectively. Patients with CLDN19 mutations also are affected with severe ocular abnormalities. The aim of our study was to identify and characterize the molecular defects causing this disease in a Georgian girl and two Spanish siblings. Clinical and biochemical parameters were studied. The CLDN16 and CLDN19 genes were analyzed by DNA sequencing. The functional consequences of the identified mutations on pre-mRNA splicing were investigated using a minigene assay. Sequence analysis revealed that the patient from Georgia was homozygous for a novel mutation, c.602G > A; p.(G201E), in exon 4 of the CLDN16 gene. The two Spanish siblings were homozygous for a new CLDN19 mutation, c.388G > T; p.(G130C), located in exon 2, and both parents were heterozygous carriers of the mutation. Bioinformatics analysis predicted that the amino acid substitutions generated by these mutations were pathogenic. Functional studies showed that mutation c.388G > T also results in partial skipping of CLDN19 exon 2, which would imply significant alterations in the claudin-19 protein structure. Conversely, CLDN16 mutation c.602G > A had no effect on pre-mRNA splicing. Our study expands the genotypic classification of this rare disease and provides the first report of a CLDN19 mutation affecting splicing.

CHRONIC RENAL FAILURE IN CHILDREN;

Introduction: Chronic renal failure is defined as progressive and irreversible lossof renal functions that gradually progress to end-stage renal disease. The etiology of chronicrenal failure in childhood correlates closely with the age of patient at the time when the renalfailure is first detected. Objectives: The aim was to assess the underlying causes and risk factorsof chronic renal failure and to identify the clinical presentation of chronic renal failure in childrenreporting at Allied Hospital Faisalabad. Study design: It was a cross sectional study. Duration ofth study: The study was done in a period of one year starting from March 20th, 2007 to March 20 ,2008. Setting: The study was done in the Department of Pediatrics medicine Allied HospitalFaisalabad. Subjects and methods: CRF was defined as glomerular filtration rate less than 25%of the normal for that age and sex. Patients of either sex ranging from 6 months to 15 yearsfulfilling the inclusion criteria were included in this study. Sampling technique was non-probabilityconvenience sampling. In addition to clinical evaluation, they were investigated to find out theunderline causes. Results: Out of 40 patients of CRF males were (n-28), females were (n-12), withmale to female ratio of 2.3:1. Mean age of males was 7.36+ 3.98 and females was 8.96+ 2.65.Etiological factors found in 34(85%) patients included congenital malformations (9-22.5%)urolithiasis (8-20%) reflux nephropathy (6-15%) glomerulopathies (3-7.5%) neurogenic bladder(2-5%) strictures (1-2.5%) and miscellaneous (5-20.5%) Etiology was unknown in 6 patients(15%). Failure to thrive 77%, Respiratory distress 75%, Pallor 75%, Fever 75%, Headache 67%,Vomiting 63%, Edema 50%, &amp; Anorexia 42% were the most common clinical features atpresentation.

AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE IN THE STRUCTURE OF CYSTIC DYSPLASIA IN CHILDREN

Cystic dysplasia is a heterogeneous group of diseases, with 12–15% share in the structure of congenital kidney anomalies and 8–10% share in the structure of the causes of chronic renal failure in children. The article presents the results of observation of patients with polycystic kidney disease. To study the clinical features of the course of various forms of cystic dysplasia in children we analyzed the histories of children with autosomal recessive and autosomal dominant polycystic kidney disease. We revealed clinical, laboratory and instrumental features of the course of various types of cystic renal dysplasia.

Posterior urethral valves: 10 years audit of epidemiologic, diagnostic and therapeutic aspects in Yaound\xe9 gynaeco-obstetric and paediatric hospital

BackgroundThe incidence of posterior urethral valve (PUV) is estimated at 1:5000–1:8000 males. It is the most common paediatric urologic urgency and the most common cause of male obstructive uropathy and chronic renal failure in children. The study aimed to describe the experience of Yaoundé gynaeco-obstetrics and paediatric hospital in the management of PUV.MethodsRetrospectively, medical records were retrieved over a ten year period and all data recorded and analyzed for study objectives. Patients were called and evaluated for outcomes regarding morbidity and mortality.ResultsA total of 18 patients all males were managed over the ten year period, given prevalence of 13 cases/100,000 admissions and an admission rate of 2 per annum. The median age at presentation was 22 months and 13 (72.2%) participants presented late. Voiding urethrocystogram was done in all the participants where it showed dilated and elongated posterior urethral valves in 16 (88.9%) of the cases. Endoscopic valve ablation resulted in the relief of obstruction in all but 3 (16.7%) participants that had residual valves and 2 (11.2%) participants that had urethral stenosis. Type I valves were most common in 14 (78.0%) participants. The mean duration of follow up was 34.56 ± 21.47 months. Complications at final follow up were: 10 (55.6%) chronic renal failure, 2 (11.2%) end-stage renal failure. The case fatality rate was 5.6%.ConclusionMany patients present late in our setting with already established complications. There is the need to counsel parents/guardians on the importance of long-term follow up after relief of obstruction.

Semaphorin-3A and Netrin-1 predict the development of kidney injury in children with congenital hydronephrosis

Congenital obstructive nephropathy is amongst the main causes of chronic renal failure in children. Early diagnosis and initiation of the treatment will delay progressive renal tubular atrophy and interstitial fibrosis with the loss of nephrons. The aim of this study was to evaluate whether urinary (u) semaphorin-3A (SEMA-3A) and Netrin-1 may be potential biomarkers in children with congenital hydronephrosis due to ureteropelvic junction obstruction (UPJO). The study consisted of 42 children with severe hydronephrosis who needed surgery and two control groups (Control One: 42 children with mild, non-obstructive hydronephrosis; Control Two: 44 healthy children). All children had normal renal function. Urinary semaphorin-3A and Netrin-1 levels were measured in different groups using immunoenzymatic ELISA commercial kits. Compared with Control One and Control Two groups, the preoperative median uSEMA-3A/creatinine (cr.) and uNetrin-1/cr. levels increased significantly in the children with severe hydronephrosis (p < .01). One month after surgery, uSEMA-3A/cr. and uNetrin-1/cr. levels had decreased significantly in the children with severe hydronephrosis (p < .01), but were still higher than those in both control groups (p < .05). Receiver operator characteristic (ROC) analyses revealed a good diagnostic profile for uSEMA-3A and uNetrin-1 in terms of identifying children with a differential renal function of <40% [area under the curve (AUC) 0.825 and 0.745, respectively]. Our results indicate that increased concentrations of uSEMA-3A and uNetrin-1 are found in urine from children with severe hydronephrosis and that their concentrations are related to the degree of obstruction.

QMPSF is sensitive and specific in the detection of NPHP1 heterozygous deletions.

Nephronophthisis, an autosomal recessive nephropathy, is responsible for 10% of childhood chronic renal failure. The deletion of its major gene, NPHP1, with a minor allele frequency of 0.24% in the general population, is the most common mutation leading to a monogenic form of childhood chronic renal failure. It is challenging to detect it in the heterozygous state. We aimed to evaluate the sensitivity and the specificity of the quantitative multiplex PCR of short fluorescent fragments (QMPSF) in its detection. After setting up the protocol of QMPSF, we validated it on 39 individuals diagnosed by multiplex ligation-dependent probe amplification (MLPA) with normal NPHP1 copy number (n=17), with heterozygous deletion (n=13, seven parents and six patients), or with homozygous deletion (n=9). To assess the rate of the deletions that arise from independent events, deleted alleles were haplotyped. The results of QMPSF and MLPA correlated perfectly in the identification of 76 heterozygously deleted and 56 homozygously deleted exons. The inter-experimental variability of the dosage quotient obtained by QMPSF was low: control, 1.05 (median; range, 0.86-1.33, n = 102 exons); heterozygous deletion, 0.51 (0.42-0.67, n = 76 exons); homozygous deletion, 0 (0-0, n = 56 exons). All patients harboring a heterozygous deletion were found to carry a hemizygous mutation. At least 15 out of 18 deletions appeared on different haplotypes and one deletion appeared de novo. The cost- and time-effective QMPSF has a 100% sensitivity and specificity in the detection of NPHP1 deletion. The potential de novo appearance of NPHP1 deletions makes its segregation analysis highly recommended in clinical practice.

The Role of a Nurse in Conducting Peritoneal Dialysis for Chronic Renal Failure in Children

Replacement renal therapy is the only method for treating the terminal stage of chronic renal failure before kidney transplantation, if such one is possible. In recent years, the frequency of outpatient peritoneal dialysis, conducted both in a hospital and at home, has increased for this purpose in children. The efficacy of dialysis and minimization of complications, especially peritonitis, depend not only on the program chosen by a doctor but also on the correct execution of the procedure and the observance of aseptic and antiseptic rules by persons performing dialysis (nurse and mother). The article introduces the basic principles of dialysis: demonstrating the role of a nurse in the procedure, the author justifies the need to improve knowledge in the field of renal replacement therapy in order to intelligently and easily explain the essence of dialysis to a mother and teach her how to perform the procedure independently.

Demographic Characteristics of Patients and Causes Leading to Chronic Renal Failure in Children Admitted to Mashhad Children Hospital

Background: An irreversible renal function impairment is called chronic renal failure (CRF) which finally leads to the “end-stage renal disease” (ESRD) and requires renal replacement therapies. The aim of this study is to evaluate the incidence, prevalence of epidemiological indicators (age, sex), and causes of chronic renal failure in children in Mashhad (one of the big cities of Iran). Methods: This is a cross-sectional study that was conducted on patients’ records over a seven-year period (2008-2014) in Doctor Sheikh Children’s Hospital of Mashhad. The inclusion criteria were all children under 20 years old diagnosed with ESRD, with a GFR less than 15 ml/min/1.73 m2 who were referred to the hospital during the study period. Patients’ information, such as age, gender, onset of dialysis, causes of constructing renal failure, and positive or negative antigen of hepatitis B was extracted from their records. Data were analyzed using SPSS 16 software. Results: A total of 326 patients were studied, of which, 56.4% were male. 45.1% were from 7 to 18 years. 56.4% of patients were on hemodialysis and others were on peritoneal dialysis. The most common cause of chronic renal failure in the study was respectively reflux nephropathy (32.9%), nephrotic syndrome (8.9%), neurogenic bladder (5.5%), stones (2.5%), glomerulopathy (2.1%) and cystinosis (1.5%) and (20.9%) had unknown cause. During the 7-year period of study considering the treatment outcomes, 69.3% of patients needed to continue the dialysis; 10.4% underwent transplantation; 10.4% unfortunately died despite of treatment and 1.5% were cured. Conclusions: It is hoped that considering the clinical symptoms of children with chronic renal failure and the diagnosis of the cause, we can reduce complications of the disease with a quick diagnosis and treatment, as well as appropriate follow-up.

ATP5B and ETFB metabolic markers in children with congenital hydronephrosis.

Congenital obstructive nephropathy is the primary cause of chronic renal failure in children. Disorders of mitochondrial energy metabolism may be a primary factor underlying tubular cell apoptosis in hydronephrosis. The β-F1-ATPase (ATP5B) and electron transfer flavoprotein β subunit (ETFB) metabolic markers are involved in mitochondrial energy metabolism in other diseases. The aim of the present study was to evaluate whether ATP5B and ETFB are represented in the hydronephrotic kidney, and whether they are associated with the progression of hydronephrosis. The cohort examined consisted of 20 children with hydronephrosis, graded III and IV using the Society for Fetal Urology grading system, and a control group consisting of 20 patients with nephroblastoma. Reverse transcription-quantitative polymerase chain reaction and immunoblot analyses were used to investigate the differential expression of genes and proteins in the two groups. The gene and protein expression levels of ATP5B and ETFB were upregulated in the hydronephrosis group. Correlation analyses revealed negative correlations between ATP5B, ETFB protein and split renal function (SRF). Receiver-operator curve analysis found a diagnostic profile of the ETFB protein in identifying children with hydronephrosis with abnormal SRF (<45%). These results suggested that increasing levels of ATP5B and ETFB were associated with worsening renal injury. ATP5B and ETFB may be novel markers in hydronephrosis and require further detailed investigation.

APPLICATION RENAL REPLACEMENT THERAPY IN CHILDREN IN KEMEROVO REGION

The paper features comparative outcomes of applying different methods of renal replacement therapy for acute renal failure and chronic renal failure in children at the pediatric dialysis unit of the Russian children’s hospital «Zonal perinatal centre» in Novokuznetsk. The use of renal replacement therapy as an optimal method for achieving adequate and effective replacement of kidney function is validated. There are treated 58 children, 37 patients with acute kidney injury and 21 with terminal chronic renal failure. Acute renal failure was prevailed in preschoolers of 1–6 years old children – 24 (64,8 %), the terminal chronic renal failure in school children and teenagers – 16 (76,2 %). The renal replacement therapy used in 5 (13,5 %) patients with septic diseases, and in 6 (16,2 %) patients with poisons diseases. Methods of renal replacement therapy is effectively cleansing of the blood in critically ill patients. This method can reduce the rate of mortality and effectively adjust homeostasis in severe infections, septic diseases, multiple organ dysfunction syndrome and in patients with poisons diseases. Application of peritoneal dialysis allows as effective replacement of renal function in the children with difficulty vascular access.